Reducing clinical variations with clinical pathways: do pathways work?
Reducing clinical variations with clinical pathways: do pathways work?
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DOI：
10.1093/intqhc/mzg057
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发表时间：
2003-12-01
影响因子：
2.6
通讯作者：
Di Stanislao, F
中科院分区：
文献类型：
--
作者：
Panella, M;Marchisio, S;Di Stanislao, F
客观的。测试 2000-2002 年意大利各种医疗保健组织的临床路径，以衡量减少过程和结果变化的绩效。设计。创建针对每个临床路径的指标，以衡量护理过程和结果的变化。分析前和分析后模型来评估临床路径对每个指标可能产生的影响。我们在六个地点测试了临床路径，每个地点都有不同的临床路径。结果。在成功实施路径的场所，医疗保健宏观变化现象（住院时间、患者路径等）和绩效微观变化（诊断和治疗处方的变化、方案实施等）减少。还证明了根据心力衰竭临床路径接受治疗的患者的结果有显着改善。结论。临床路径的总体目的是通过提供协调护理并减少碎片化和最终成本的机制来改善结果。我们的结果表明，实现这一目标是可能的。尽管仍然存在争议因素，但我们认为临床路径可以对医疗保健质量产生积极影响。
Objective. To test clinical pathways in a variety of Italian health care organizations in 2000-2002 to measure performance in decreasing process and outcome variations.Design. Creation of indicators, specific for each clinical pathway, to measure variations in the care processes and outcomes. Pre- and post-analysis model to evaluate the possible effect of the clinical pathways on each indicator.Setting. We tested the clinical pathways in six sites, each with different clinical pathways.Results. Reductions in health care macro-variation phenomena (length of stay, patient pathways, etc.) and in performance micro-variation (variations in diagnostic and therapeutic prescriptions, protocol implementation, etc.) were shown in sites where pathways were implemented successfully. A significant improvement in outcome for patients who were treated according to the clinical pathway for heart failure was also demonstrated.Conclusions. The overall purpose of clinical pathways is to improve outcome by providing a mechanism to coordinate care and to reduce fragmentation, and ultimately cost. Our results demonstrated that it is possible to achieve this goal. Although controversial elements still exist, we think that clinical pathways can have a positive impact on quality in health care.